No-Fault Case Law

The court considered an appeal from a judgment in favor of Parkview Medical & Surgical, P.C., as assignee of Ralph Allison, against Allstate Insurance Company. The main issue was whether a no-fault provider had established its prima facie entitlement to judgment as a matter of law, based on submitting evidence that claim forms were mailed to and received by the defendant insurer, and whether the defendant had failed to pay or deny the claims within the prescribed 30-day period. The holding of the case was that the judgment in favor of the plaintiff was reversed, the original order was vacated, and the plaintiff's motion for summary judgment was ultimately denied. The court found that the plaintiff had failed to meet its initial burden of establishing its prima facie entitlement to judgment as a matter of law, and there was a triable issue of fact demonstrated by the defendant's evidence.

The main issue in the case was whether the provider could recover assigned first-party no-fault benefits when the insured failed to appear for duly scheduled examinations under oath and independent medical examinations. The court considered the proof submitted by the defendant showing that the scheduling letters for the examinations were timely mailed, and that the insured failed to appear for any of the scheduled examinations. The court also noted that the failure to send a denial in duplicate was not a fatal error. Since the insured's appearance at any properly scheduled examination was a condition precedent to the insurer's liability, the court granted the defendant's motion for summary judgment dismissing the complaint. The relevant facts considered were the timely mailing of the examination scheduling letters and the insured's failure to appear for the examinations.

The relevant facts the court considered in this case were a dispute between an insurance company and a medical provider over the failure of a patient to appear for scheduled independent medical examinations (IMEs), which is a condition precedent to the insurer's liability on a policy. The insurance company, appellant, had motioned for summary judgment dismissing the complaint and submitted evidence that the IME requests had been timely mailed, and that the patient failed to appear for the scheduled IMEs. The medical provider, respondent, had cross-moved for summary judgment and claimed that the insurance company failed to provide discovery responses within the stipulated time. The main issues decided were whether the insurance company had failed to comply with the so-ordered stipulation and whether there was an issue of fact as to whether the insurance company is barred from interposing its defense due to an alleged failure to comply. The holding was that the judgment was reversed, the order granting the plaintiff's cross motion for summary judgment was vacated, and the plaintiff's cross motion for summary judgment was denied, with the appeals court determining that there was an issue of fact as to whether the insurance company is barred from raising its defense.

The relevant facts the court considered in this case were that the plaintiff, Alleviation Medical Services, P.C., was seeking to recover first-party no-fault benefits from the defendant, Geico Ins. Co., as an assignee of Rayvon Freeman. The main issue decided was whether the plaintiff was entitled to summary judgment in their favor. The court held that the plaintiff's motion for summary judgment was properly denied, as their papers failed to establish that the defendant had failed to pay or deny the claim within the required 30-day period, as mandated by Insurance Law. Additionally, the court found that the plaintiff had not proven that the defendant issued a timely denial of claim that was conclusory, vague, or without merit as a matter of law. Therefore, the court affirmed the lower court's decision to deny plaintiff's motion for summary judgment.

The relevant facts considered by the court were that the plaintiff, Cortland Medical Supply, P.C., was seeking to recover assigned first-party no-fault benefits from the defendant, Praetorian Ins. Co. The defendant had moved for summary judgment to dismiss the complaint, arguing that the plaintiff's assignor had failed to appear for scheduled independent medical examinations (IMEs), which is a condition precedent to the insurer's liability under the policy. The main issue decided by the court was whether the defendant had sufficiently established that the IME requests had been timely mailed and that the assignor had failed to appear for the scheduled IMEs. The holding of the case was that the court reversed the order and granted the defendant's motion for summary judgment dismissing the complaint, ruling that the defendant had indeed established the timely mailing of IME requests and the assignor's failure to appear for the IMEs, which justified the denial of the claims.

The court considered the motion for summary judgment by the plaintiff and the cross-motion for summary judgment by the defendant in a case brought by a provider to recover assigned first-party no-fault benefits. The main issue was whether the defendant was entitled to summary judgment dismissing the plaintiff's first and second causes of action. The court held that the defendant was entitled to summary judgment dismissing the second cause of action because the plaintiff's assignor had failed to appear for independent medical examinations (IMEs) as scheduled, which was a condition precedent to the insurer's liability. The court also awarded summary judgment to the defendant dismissing the plaintiff's first cause of action, as the record established that the assignor had failed to appear for the scheduled IMEs. Therefore, the court affirmed the lower court's order and awarded summary judgment to the defendant dismissing both of the plaintiff's causes of action.

The relevant facts of this case involve Longevity Medical Supply, Inc. seeking to recover first-party no-fault benefits from Geico Ins. Co. On appeal from the Civil Court of the City of New York, Longevity argued that Geico failed to establish that Longevity's assignor had failed to appear for scheduled examinations under oath (EUOs), and therefore Longevity's motion for summary judgment should have been granted and Geico's cross motion for summary judgment should have been denied. However, the affidavits submitted by Geico were deemed sufficient to establish that Longevity's assignor had failed to appear for the scheduled EUOs. The court held that since the assignor's appearance at the EUO is a condition precedent to the insurer's liability on the policy, the order denying Longevity's motion and granting Geico's cross motion for summary judgment was affirmed.

The court considered the motion for summary judgment by the plaintiff, Rainbow Supply of NY, Inc., as assignee of Georgia Brown and Vanessa Thompson, and the cross motion for summary judgment by the defendant, Geico General Ins. Co., in a case involving the recovery of assigned first-party no-fault benefits. The main issue decided was whether the defendant had timely and properly denied the claims based on a lack of medical necessity for the supplies at issue. The court held that the defendant's cross motion for summary judgment dismissing the complaint was granted, as the plaintiff's affidavit failed to rebut the conclusions set forth in the peer review reports submitted by the defendant. The court found that defendant was otherwise entitled to judgment and reversed the decision of the Civil Court, vacating the findings in plaintiff's favor and granting defendant's cross motion for summary judgment.

The relevant facts considered in this case were that A.M. Medical, P.C. was seeking to recover no-fault benefits from Encompass Insurance Company, and the claim forms at issue were received by Encompass on or before February 8, 2001. The main issue decided was whether the action, commenced in June 2007, was untimely based on the six-year statute of limitations for contract actions. The court held that Encompass had established that the claim forms were received by them on or before February 8, 2001, and thus the action, commenced in June 2007, was untimely. Therefore, the court reversed the order and granted Encompass' motion for summary judgment dismissing the complaint insofar as asserted against them.

The main issue in this case was whether defendant failed to pay or deny the claim within the requisite 30-day period as required by Insurance Law § 5106. Plaintiff's motion for summary judgment was denied, as they failed to establish that defendant had issued a timely denial of claim, or that defendant had not received the claim in question. An affidavit by the defendant's claims representative was sufficient to establish that the defendant did not receive the claim underlying the plaintiff's third cause of action, but the plaintiff's owner demonstrated that the claim form had been mailed to defendant. As a result, there was an issue of fact as to whether defendant's time to pay or deny the claim began to run. Therefore, the court modified the order to deny the defendant's cross motion for summary judgment.